title: Use of implementation theory: a focus on PARIHS.
abstract: BACKGROUND
  Limited understanding and application of theory in implementation research contributes to variable effectiveness of implementation studies. Better understanding of direct experiences with theory could improve implementation research and the potency of interventions.
  
  
  OBJECTIVE
  This study was a conceptual exercise aimed at characterizing experiences with and applications of the Promoting Action on Research Implementation in Health Services (PARIHS) framework.
  
  
  METHODS
  This was a structured, qualitative study involving document reviews and interviews used to answer the following overarching questions about nine implementation research centers: Why and how was PARIHS used? What strengths and weaknesses were identified for PARIHS?
  
  
  RESULTS
  PARIHS was being used for varied purposes, at varied levels, in varied ways, and to a varying extent within and across centers. Lack of implementation theory use in investigators' early years was common. Variability in the nature of theory use was attributable to characteristics of the centers, individual investigators, and features of PARIHS. Strengths and weaknesses of the PARIHS framework were identified.
  
  
  CONCLUSIONS
  The study provides information to researchers and theorists about the use of one well-known implementation framework. The information suggests areas for improvements in PARIHS as well as theory use in general, and should assist in the development of theory-based programs of research.
authors.affiliation: Research Scientist, Spinal Cord Injury QUERI, VA Puget Sound Health Care System, Seattle, WA.
authors.forename: Philip M
authors.initials: PM
authors.lastname: Ullrich
authors.forename: Anju
authors.initials: A
authors.lastname: Sahay
authors.forename: Cheryl B
authors.initials: CB
authors.lastname: Stetler
mesh_terms: D004282:Documentation / Q000379:methods; D017598:Efficiency, Organizational; D055318:Evidence-Based Nursing / Q000379:methods* / Q000458:organization & administration*; D006302:Health Services Research / Q000379:methods*; D006801:Humans; D007407:Interviews as Topic; D015401:Nursing Administration Research / Q000379:methods*; D015403:Nursing Evaluation Research; D009742:Nursing Theory; D036301:Qualitative Research
keywords: PARIHS; context; effectiveness; evidence; facilitation; framework; health services; implementation; theory; translation